A nurse is caring for a client who is 3 days postoperative following open heart surgery and will be transferred to the medical-surgical unit. Which of the following information should the nurse plan to include in the verbal report?

The client's dressing change schedule.

The client's level of consciousness.

The client's vital signs from the previous shift.

The client's occupation.

Answer and Explanation

The Correct Answer is B

Choice A rationale:

The nurse should not include the client's dressing change schedule in the verbal report when transferring care to the medical-surgical unit. While this information is important for the client's care, it is not a priority for the receiving unit to know during the immediate transfer. Dressing change schedules can vary based on the type of surgery and wound healing progress, and the medical-surgical unit will focus on the client's overall condition.

Choice B rationale:

The client's level of consciousness is a critical piece of information to include in the verbal report when transferring care. Changes in level of consciousness can indicate neurological deterioration or potential complications, especially after a major surgery like open heart surgery. This information helps the receiving nurses monitor the client's condition closely and respond appropriately if any deterioration occurs.

Choice C rationale:

While reporting the client's vital signs from the previous shift is important, it might not be the most relevant information during the immediate transfer from the postoperative unit to the medical-surgical unit. Vital signs can change rapidly, and the receiving nurses will assess the client's current vital signs upon arrival. Therefore, this information is not the priority for the verbal report.

Choice D rationale:

The client's occupation is not a critical piece of information to include in the verbal report during a transfer from the postoperative unit to the medical-surgical unit. The primary focus of the transfer report should be on the client's immediate postoperative condition, potential complications, and any other information directly related to their current medical status.

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Correct Answer is ["A","C","D","E"]

Explanation

The correct answers are choices A, C, D, and E:

Choice A rationale: The right to be treated with respect and dignity is a fundamental client right in any healthcare setting, including long-term care facilities. This right ensures that clients receive care in a compassionate and respectful manner.
Choice B rationale: Full access to the facility is not a standard client right in long-term care facilities. Access to certain areas might be restricted for safety reasons or to maintain privacy.
Choice C rationale: The right to refuse medications is an essential aspect of client autonomy, allowing clients to make informed decisions about their care. It is important to address this right during orientation.
Choice D rationale: The right to leave regardless of provider recommendations is another aspect of client autonomy. Clients should be informed of their right to refuse care or leave the facility if they wish, even if it goes against the advice of healthcare providers.
Choice E rationale: The right to be fully informed of their health conditions is a crucial aspect of client autonomy and transparency in healthcare. Clients should be aware of their health status and treatment options to make informed decisions about their care.

In conclusion, when conducting an orientation class for new clients and their families at a long-term care facility, the nurse should address the rights to be treated with respect and dignity, refuse medications, leave the facility (even if it is against the recommendations of healthcare providers), and be fully informed of their health conditions.

A. Report the findings to the hospital ethics committee. B. Alert central supply. C. Fill out an incident report. D. Notify the quality improvement team.

Correct Answer is D

Explanation

Choice A rationale:

Reporting the findings to the hospital ethics committee is not the appropriate action in this scenario. Ventilator-associated pneumonia (VAP) is a clinical issue related to patient care and safety, not an ethical concern. The hospital ethics committee is generally responsible for addressing ethical dilemmas and conflicts.

Choice B rationale:

Alerting central supply is not the correct action in this situation. Central supply typically handles the procurement and distribution of medical supplies, equipment, and materials. While maintaining proper equipment and supplies is important, addressing VAP requires a focus on infection prevention and patient care practices.

Choice C rationale:

Filling out an incident report is not the best course of action for addressing an increase in ventilator-associated pneumonia. Incident reports are typically used to document unexpected events, accidents, or errors that occur in the healthcare setting. However, addressing the rise in VAP involves implementing measures to prevent and control infections, which falls under the purview of the quality improvement team.

Choice D rationale:

The correct action is to notify the quality improvement team. Ventilator-associated pneumonia is a healthcare-associated infection that can lead to serious complications for patients on ventilators. The quality improvement team is responsible for monitoring and improving the quality of patient care, including infection prevention and control. By notifying the quality improvement team, the nurse manager can initiate a comprehensive review of current practices, identify potential areas for improvement, and implement evidence-based interventions to reduce the incidence of VAP.

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A nurse is caring for a client who is 3 days postoperative following open heart surgery and will be transferred to the medical-surgical unit. Which of the following information should the nurse plan to include in the verbal report?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is conducting an orientation class for new clients and their families at a long-term care facility. Which of the following client rights should the nurse address at the orientation? (Select all that apply.).

Correct Answer is ["A","C","D","E"]

Explanation

A nurse manager is auditing client charts and identifies an increase in ventilator-associated pneumonia (VAP). Which of the following actions should the nurse manager take?

Correct Answer is D

Explanation

A nurse is providing preoperative teaching for a client who is scheduled for a total knee arthroplasty and speaks a different language than the nurse. Which of the following interprofessional team members should the nurse include in the discussion?

A nurse manager is teaching about confidentiality requirements to the staff. Which of the following staff comments indicates an understanding of the teaching?

A hospice nurse is planning care for a client who does not have advance directives. Which of the following interventions should the nurse include in the plan of care?

A nurse from a medical unit is asked to work on an orthopedic unit. The medical nurse has no orthopedic experience. Which of the following clients should be assigned to the medical nurse?

A nurse on a medical-surgical unit is caring for a client transferred from another department. The nurse should verify that the client has given informed consent prior to which of the following procedures?

A client is considering having a tubal ligation and reports being uncertain about if it is the right thing to do. Which of the following actions should the nurse take?

A nurse is developing a discharge plan for a client who is postoperative and will require a wheelchair in the home. The nurse should place a referral to which of the following resources to assist the client with this need?

A nurse is preparing to administer medication to a client who has Crohn's disease. The client states, "I want to skip this dose of my medication. I am too tired to take it." Which of the following actions should the nurse take?